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General NPI Number Information
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NPI Number | 1881472322
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Entity Type | Individual
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Provider Name | OLMEDO IZQUIERDO GOMEZ MSW
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Gender | Male
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Dates
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Enumeration Date | 09/18/2023
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Last Update Date | 05/11/2025
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Provider Practice Location Address
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Address Line | 4700 MILLENIA BLVD STE 500
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City | ORLANDO
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State | FL
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Zip | 32839-6019
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Country | US
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Telephone | 407-697-3266
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Fax |
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Provider Business Mailing Address
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Address Line | 3200 OLD WINTER GARDEN RD APT 2712
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City | OCOEE
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State | FL
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Zip | 34761-4537
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Country | US
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Telephone | 407-723-3387
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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